The process of launching a wet lab for cataract surgery on the goat's eye for publication and use of the respectable colleague surgeons of the ophthalmology department is presented as follows.
In order to design an effective and beneficial wet lab, we followed and implemented five main steps as follows:
Step 1: Preparing an appropriate physical space
To have a proper wet lab space, a room in Feiz Educational-Therapeutic Ophthalmology Center, affiliated to Isfahan University of Medical Sciences, was considered and prepared. Therefore, after cabinets, plumbing, cooling and heating equipment, and electricity, and telephone system were set up in the room, the required facilities including surgical microscope, the phaco machine, microwave, Trypan blue, extracapsular surgery set, phaco surgery set, safety box, refrigerator, desk, and chair were transferred.
Step 2: Obtaining finance to launch the wet lab
After coordination was made, we received and packed surgery sets using the old equipment from the operating room. Since modern equipment was purchased for the hospital operating room, we were able to transfer the phaco machine and microscopes that were no longer in use. Consumables and goat's eyes were not expensive, and a total of 30 goat's eyes were used.
In this physical space, a senior assistant performed the procedure step-by-step on a goat's eye, and the sophomore assistant followed the instruction as an observer and subsequently exercised it on a goat's eye. Other exercises in the wet lab comprised of scrub, introduction to ophthalmology surgery devices and microscope set-up, and stitching.
Step 3: Providinggoat's eye
To provide the eyes, the slaughterhouse (60 km to Isfahan) was reminded to extract the eyes from the animal's eye orbit in perfect form along with the surrounding fat without the eye surface being touched. The eyes were transferred to the wet lab in cold box at -2 °C inside the dextrose-saline solution. The temperature of the refrigerator was set at -2 °C to keep the eyes. Nevertheless, the cornea should not be dried or frozen. Notably, as the time between the displacement of the eyes from the slaughterhouse and their use in the wet lap and cataract surgery was long, the eyes were kept and transferred in 2/3 and 1/3 serums and a temperature of -2°C in order to prevent corneal opacity.
Goat’s eye was selected given its resemblance to the human eye and accessibility(1). The similarity helps us train the procedures to the assistants and to enable them to practice on their own.
Step 4: Stabilizing the eye
In keeping with the need for eye fixation, researchers used magnetic clip dispensers, as an innovative technique, to stabilize the eye. Bottom of the dispenser was filled with compressed cotton, and the eye was placed on it. We placed the head of the dispenser on the animal's eye so that the eye was accessible from the empty circular space of the dispenser head.
Step5: Preparing the eye for cataract surgery
Given the fact the goat's eye is deprived of vital nerves at the time of slaughter, that the pupil gets dilated, and that the eye was transferred under moist conditions inside 1/3 and 2/3 serums at -2 °Cin order to prevent from the cornea’s dryness and opacity, it was necessary to take certain measures on the goat's eye, because the goat’s eye lenses are made up of a loose, transparent tissue. Therefore, to make it more solid and darker, we induced cataract in the microwave according to our previous studies. It is necessary to explain that cataract induction on the goat's eye is performed for the first time worldwide, and what was observed in articles(2-3)concerned with the porcine eye, which was carried out at a power of 700 w in the microwave for 5-13 seconds. In this study, we evaluated that the goat's eye is different from that of the pig's, and that it has a tissue more susceptible to microwave conditions that the porcine eye such that it transforms in a faster time.
Thus, cataract induction of the goat's eye in the microwave was the first experience. Hence, as we did not have a reference in this regard, we checked the eye in the microwave every 3 seconds, observing that within 9 to 13 seconds at a temperature of 100 °C, total induction was accomplished and the cornea was still transparent for practicing rhexis and phaco in the wet lab. In this way, the goat eye lenses were prepared for cataract procedures including the anterior capsule, rhexis, phaco, irrigation and aspiration, IOL(Inter Ocular Lens), and stromal hydration. We found that the eye cataract could be used for surgical purposes for up to 24 hours after surgery in case they were stored inside a container with a lid under refrigerated conditions or in water. At these intervals, the necessary condition is for the cornea to remain transparent, which was considered by us in the operational plan.